MEDICARE: ESTA K KAFTAN LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	44SC047870000	NJ

General Provider Information

NPI Number	:	1376604058
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ESTA K KAFTAN LCSW

Provider Business Mailing Address
First Line	:	2115 MILLBURN AVE
Second Line	:	SUITE 100
City	:	MAPLEWOOD
State	:	NJ
Zip	:	07040-3724
Country	:	US
Telephone Number	:	973-420-6251
Fax Number	:	908-228-5363

Provider Business Practice Location Address
First Line	:	2115 MILLBURN AVE
Second Line	:	SUITE 100
City	:	MAPLEWOOD
State	:	NJ
Zip	:	07040-3724
Country	:	US
Telephone Number	:	973-420-6251
Fax Number	:	908-228-5363

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/13/2006
Last Update Date	:	03/19/2012

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